Difference between revisions of "Embryonal carcinoma"

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| Width      =
| Width      =
| Caption    = Embryonal carcinoma. [[H&E stain]].
| Caption    = Embryonal carcinoma. [[H&E stain]].
| Micro      = vesicular nuclei, nuclear overlap, necrosis (common), mitoses, variable architecture (tubulopapillary, glandular, solid, embryoid bodies)
| Micro      = [[vesicular nuclei]], nuclear overlap, necrosis (common), mitoses, variable architecture (tubulopapillary, glandular, solid, embryoid bodies)
| Subtypes  =
| Subtypes  =
| LMDDx      = [[seminoma]], [[mixed germ cell tumour]], [[yolk sac tumour]], other carcinomas
| LMDDx      = [[seminoma]], [[mixed germ cell tumour]], [[yolk sac tumour]], other carcinomas
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| IF        =
| IF        =
| Gross      =
| Gross      =
| Grossing  =
| Grossing  = [[orchiectomy grossing]]
| Staging    = [[testicular cancer staging]]
| Site      = [[testis]], [[ovary]], [[mediastinum]]
| Site      = [[testis]], [[ovary]], [[mediastinum]]
| Assdx      =
| Assdx      =
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| Signs      = testicular mass, pelvic mass
| Signs      = testicular mass, pelvic mass
| Symptoms  =
| Symptoms  =
| Prevalence =
| Prevalence = pure embryonal uncommon
| Bloodwork  =
| Bloodwork  =
| Rads      =
| Rads      =
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| Prognosis  =
| Prognosis  =
| Other      =
| Other      =
| ClinDDx    =
| ClinDDx    = typically other [[testicle|testicular tumours]]
}}
}}
'''Embryonal carcinoma''' is a type of [[germ cell tumour]].  It is commonly as a component of [[mixed germ cell tumour]]s.
'''Embryonal carcinoma''' is a type of [[germ cell tumour]].  It is commonly as a component of [[mixed germ cell tumour]]s.
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*Affects young adults.
*Affects young adults.
**May be seen in women.
**May be seen in women.
*Usually a component of a [[mixed germ cell tumour]] - in the [[testicle]] 85% of cases are mixed, only 15% are pure.<ref name=pmid24503753/>


==Gross==
==Gross==
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Features:<ref name=Ref_GUP549>{{Ref GUP|549}}</ref>
Features:<ref name=Ref_GUP549>{{Ref GUP|549}}</ref>
#Nucleoli - '''key feature'''.
#Nucleoli - '''key feature'''.
#Vesicular nuclei (clear, empty appearing nuclei) - '''key feature'''.
#[[Vesicular nuclei]] (clear, empty appearing nuclei) - '''key feature'''.
#Nuclei overlap.
#Nuclei overlap.
#[[Necrosis]] - common.
#[[Necrosis]] - common.
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#Indistinct cell borders
#Indistinct cell borders
#Mitoses - common.
#Mitoses - common.
#Variable architecture:
#Variable architecture:<ref name=pmid24503753>{{Cite journal  | last1 = Kao | first1 = CS. | last2 = Ulbright | first2 = TM. | last3 = Young | first3 = RH. | last4 = Idrees | first4 = MT. | title = Testicular embryonal carcinoma: a morphologic study of 180 cases highlighting unusual and unemphasized aspects. | journal = Am J Surg Pathol | volume = 38 | issue = 5 | pages = 689-97 | month = May | year = 2014 | doi = 10.1097/PAS.0000000000000171 | PMID = 24503753 }}</ref>
#*Tubulopapillary.
#*Solid (predominant in ~55% of cases).
#*Glandular.
#*Glandular (predominant in ~17% of cases).
#*Solid.  
#*Papillary (predominant in ~11% of cases).
#*Nested.
#*Micropapillary.
#*Anastomosing glandular.
#*Sieve-like glandular.
#*Pseudopapillary.
#*Blastocyst-like.
#*Embryoid bodies - ball of cells in surrounded by empty space on three sides.
#*Embryoid bodies - ball of cells in surrounded by empty space on three sides.


Notes:
Notes:
*Cytoplasmic staining variable (eosinophilic to basophilic).
*Cytoplasmic staining variable (eosinophilic to basophilic).
*[[Syncytiotrophoblasts]] commonly seen (~40-50% of cases<ref name=pmid24503753/>).


DDx:
DDx:
*[[Mixed germ cell tumour]].
*[[Mixed germ cell tumour]].
*[[Yolk sac tumour]].
*[[Yolk sac tumour]].
*[[Seminoma]].


===Images===
===Images===
Line 72: Line 82:


==IHC==
==IHC==
[[ISUP]] consensus paper by Ulbright ''et al.'':<ref name=pmid24832161>{{cite journal |author=Ulbright TM, Tickoo SK, Berney DM, Srigley JR |title=Best practices recommendations in the application of immunohistochemistry in testicular tumors: report from the international society of urological pathology consensus conference |journal=Am. J. Surg. Pathol. |volume=38 |issue=8 |pages=e50–9 |year=2014 |month=August |pmid=24832161 |doi=10.1097/PAS.0000000000000233 |url=}}</ref>
===ISUP consensus===
General panel:<ref name=pmid24832161>{{cite journal |author=Ulbright TM, Tickoo SK, Berney DM, Srigley JR |title=Best practices recommendations in the application of immunohistochemistry in testicular tumors: report from the international society of urological pathology consensus conference |journal=Am. J. Surg. Pathol. |volume=38 |issue=8 |pages=e50–9 |year=2014 |month=August |pmid=24832161 |doi=10.1097/PAS.0000000000000233 |url=}}</ref>
*OCT4 +ve.
*OCT4 +ve.
**Choriocarcinoma, yolk sac tumour and spermatocytic seminoma all -ve.
**Choriocarcinoma, yolk sac tumour and spermatocytic seminoma all -ve.
Line 80: Line 91:
**+ve in [[seminoma]].
**+ve in [[seminoma]].


Additional notes:
===Additional notes===
*CK19 -ve.<ref>{{Cite journal  | last1 = Bremmer | first1 = F. | last2 = Ströbel | first2 = P. | last3 = Hubertus | first3 = H. | last4 = Strecker | first4 = J. | last5 = Gaisa | first5 = N. | last6 = Strauß | first6 = A. | last7 = Schweyer | first7 = S. | last8 = Radzun | first8 = H-J. | last9 = Behnes | first9 = C-L | title = CK19 is a sensitive marker for yolk sac tumours of the testis. | journal = Diagnostic Pathology | volume = 10 | issue = 7 | pages = | month =  | year = 2015 | doi = 10.1186/s13000-015-0243-y | PMID =  | url = www.diagnosticpathology.org/content/10/1/7‎Cached }}</ref>
**[[Yolk sac tumour]] +ve, seminoma -ve, [[GCNIS]] (ITGCN) -ve, normal testis -ve.
*AE1/AE3 +ve.
*AE1/AE3 +ve.
*OCT3/4 +ve.<ref name=pmid18045648>{{Cite journal  | last1 = Iczkowski | first1 = KA. | last2 = Butler | first2 = SL. | last3 = Shanks | first3 = JH. | last4 = Hossain | first4 = D. | last5 = Schall | first5 = A. | last6 = Meiers | first6 = I. | last7 = Zhou | first7 = M. | last8 = Torkko | first8 = KC. | last9 = Kim | first9 = SJ. | title = Trials of new germ cell immunohistochemical stains in 93 extragonadal and metastatic germ cell tumors. | journal = Hum Pathol | volume = 39 | issue = 2 | pages = 275-81 | month = Feb | year = 2008 | doi = 10.1016/j.humpath.2007.07.002 | PMID = 18045648 }}</ref>
*OCT3/4 +ve.<ref name=pmid18045648>{{Cite journal  | last1 = Iczkowski | first1 = KA. | last2 = Butler | first2 = SL. | last3 = Shanks | first3 = JH. | last4 = Hossain | first4 = D. | last5 = Schall | first5 = A. | last6 = Meiers | first6 = I. | last7 = Zhou | first7 = M. | last8 = Torkko | first8 = KC. | last9 = Kim | first9 = SJ. | title = Trials of new germ cell immunohistochemical stains in 93 extragonadal and metastatic germ cell tumors. | journal = Hum Pathol | volume = 39 | issue = 2 | pages = 275-81 | month = Feb | year = 2008 | doi = 10.1016/j.humpath.2007.07.002 | PMID = 18045648 }}</ref>
*D2-40 -ve.<ref name=pmid18045648/>
*D2-40 -ve.<ref name=pmid18045648/>
**Iczkowski ''et al.'' suggest it is useful for discriminating from [[seminoma]].  This is somewhat disputed by Lau ''et al.''<ref name=pmid17277761>{{Cite journal  | last1 = Lau | first1 = SK. | last2 = Weiss | first2 = LM. | last3 = Chu | first3 = PG. | title = D2-40 immunohistochemistry in the differential diagnosis of seminoma and embryonal carcinoma: a comparative immunohistochemical study with KIT (CD117) and CD30. | journal = Mod Pathol | volume = 20 | issue = 3 | pages = 320-5 | month = Mar | year = 2007 | doi = 10.1038/modpathol.3800749 | PMID = 17277761 }}</ref>
**Iczkowski ''et al.'' suggest it is useful for discriminating from [[seminoma]].  This is somewhat disputed by Lau ''et al.''<ref name=pmid17277761>{{Cite journal  | last1 = Lau | first1 = SK. | last2 = Weiss | first2 = LM. | last3 = Chu | first3 = PG. | title = D2-40 immunohistochemistry in the differential diagnosis of seminoma and embryonal carcinoma: a comparative immunohistochemical study with KIT (CD117) and CD30. | journal = Mod Pathol | volume = 20 | issue = 3 | pages = 320-5 | month = Mar | year = 2007 | doi = 10.1038/modpathol.3800749 | PMID = 17277761 }}</ref>
*PLAP +ve.<ref name=pmid6209917>{{Cite journal  | last1 = Jacobsen | first1 = GK. | last2 = Nørgaard-Pedersen | first2 = B. | title = Placental alkaline phosphatase in testicular germ cell tumours and in carcinoma-in-situ of the testis. An immunohistochemical study. | journal = Acta Pathol Microbiol Immunol Scand A | volume = 92 | issue = 5 | pages = 323-9 | month = Sep | year = 1984 | doi =  | PMID = 6209917 }}</ref>
*[[PLAP]] +ve.<ref name=pmid6209917>{{Cite journal  | last1 = Jacobsen | first1 = GK. | last2 = Nørgaard-Pedersen | first2 = B. | title = Placental alkaline phosphatase in testicular germ cell tumours and in carcinoma-in-situ of the testis. An immunohistochemical study. | journal = Acta Pathol Microbiol Immunol Scand A | volume = 92 | issue = 5 | pages = 323-9 | month = Sep | year = 1984 | doi =  | PMID = 6209917 }}</ref>


==See also==
==See also==

Revision as of 20:57, 26 April 2016

Embryonal carcinoma
Diagnosis in short

Embryonal carcinoma. H&E stain.
LM vesicular nuclei, nuclear overlap, necrosis (common), mitoses, variable architecture (tubulopapillary, glandular, solid, embryoid bodies)
LM DDx seminoma, mixed germ cell tumour, yolk sac tumour, other carcinomas
IHC OCT3 +ve, CD30 +ve, AE1/AE3 +ve, CD117 -ve
Grossing notes orchiectomy grossing
Staging testicular cancer staging
Site testis, ovary, mediastinum
Signs testicular mass, pelvic mass
Prevalence pure embryonal uncommon
Clin. DDx typically other testicular tumours

Embryonal carcinoma is a type of germ cell tumour. It is commonly as a component of mixed germ cell tumours.

General

Gross

Microscopic

Features:[3]

  1. Nucleoli - key feature.
  2. Vesicular nuclei (clear, empty appearing nuclei) - key feature.
  3. Nuclei overlap.
  4. Necrosis - common.
    • Not commonly present in seminoma.
  5. Indistinct cell borders
  6. Mitoses - common.
  7. Variable architecture:[1]
    • Solid (predominant in ~55% of cases).
    • Glandular (predominant in ~17% of cases).
    • Papillary (predominant in ~11% of cases).
    • Nested.
    • Micropapillary.
    • Anastomosing glandular.
    • Sieve-like glandular.
    • Pseudopapillary.
    • Blastocyst-like.
    • Embryoid bodies - ball of cells in surrounded by empty space on three sides.

Notes:

  • Cytoplasmic staining variable (eosinophilic to basophilic).
  • Syncytiotrophoblasts commonly seen (~40-50% of cases[1]).

DDx:

Images

  • Embryonal carcinoma - very high mag. - cropped (WC/Nephron)

  • Embryonal carcinoma - high mag. (WC/Nephron)

  • Embryonal carcinoma - high mag. (WC/Nephron)

  • Embryonal carcinoma - intermed. mag. (WC/Nephron)

  • Embryonal carcinoma - low mag. (WC/Nephron)

IHC

ISUP consensus

General panel:[4]

  • OCT4 +ve.
    • Choriocarcinoma, yolk sac tumour and spermatocytic seminoma all -ve.
  • CD30 +ve.
  • CD117 -ve.[5]

Additional notes

  • CK19 -ve.[6]
  • AE1/AE3 +ve.
  • OCT3/4 +ve.[7]
  • D2-40 -ve.[7]
    • Iczkowski et al. suggest it is useful for discriminating from seminoma. This is somewhat disputed by Lau et al.[5]
  • PLAP +ve.[8]

See also

References

  1. ↑ 1.0 1.1 1.2 Kao, CS.; Ulbright, TM.; Young, RH.; Idrees, MT. (May 2014). "Testicular embryonal carcinoma: a morphologic study of 180 cases highlighting unusual and unemphasized aspects.". Am J Surg Pathol 38 (5): 689-97. doi:10.1097/PAS.0000000000000171. PMID 24503753.
  2. ↑ Yalçın, B.; Demir, HA.; Tanyel, FC.; Akçören, Z.; Varan, A.; Akyüz, C.; Kutluk, T.; Büyükpamukçu, M. (Oct 2012). "Mediastinal germ cell tumors in childhood.". Pediatr Hematol Oncol 29 (7): 633-42. doi:10.3109/08880018.2012.713084. PMID 22877235.
  3. ↑ Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 549. ISBN 978-0443066771.
  4. ↑ Ulbright TM, Tickoo SK, Berney DM, Srigley JR (August 2014). "Best practices recommendations in the application of immunohistochemistry in testicular tumors: report from the international society of urological pathology consensus conference". Am. J. Surg. Pathol. 38 (8): e50–9. doi:10.1097/PAS.0000000000000233. PMID 24832161.
  5. ↑ 5.0 5.1 Lau, SK.; Weiss, LM.; Chu, PG. (Mar 2007). "D2-40 immunohistochemistry in the differential diagnosis of seminoma and embryonal carcinoma: a comparative immunohistochemical study with KIT (CD117) and CD30.". Mod Pathol 20 (3): 320-5. doi:10.1038/modpathol.3800749. PMID 17277761.
  6. ↑ Bremmer, F.; Ströbel, P.; Hubertus, H.; Strecker, J.; Gaisa, N.; Strauß, A.; Schweyer, S.; Radzun, H-J. et al. (2015). [www.diagnosticpathology.org/content/10/1/7‎Cached "CK19 is a sensitive marker for yolk sac tumours of the testis."]. Diagnostic Pathology 10 (7). doi:10.1186/s13000-015-0243-y. www.diagnosticpathology.org/content/10/1/7‎Cached.
  7. ↑ 7.0 7.1 Iczkowski, KA.; Butler, SL.; Shanks, JH.; Hossain, D.; Schall, A.; Meiers, I.; Zhou, M.; Torkko, KC. et al. (Feb 2008). "Trials of new germ cell immunohistochemical stains in 93 extragonadal and metastatic germ cell tumors.". Hum Pathol 39 (2): 275-81. doi:10.1016/j.humpath.2007.07.002. PMID 18045648.
  8. ↑ Jacobsen, GK.; Nørgaard-Pedersen, B. (Sep 1984). "Placental alkaline phosphatase in testicular germ cell tumours and in carcinoma-in-situ of the testis. An immunohistochemical study.". Acta Pathol Microbiol Immunol Scand A 92 (5): 323-9. PMID 6209917.
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